| Laura Marie Separa Therapy Services | |
|
610 Sw Alder St Suite 1100 Portland OR 97205-3625 | |
| (503) 724-0943 | |
| Not Available |
| Full Name | Laura Marie Separa Therapy Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 610 Sw Alder St, Portland, Oregon |
| Authorized Official Name and Position | Laura Marie Separa (MA, LPC) |
| Authorized Official Contact | 5037240943 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laura Marie Separa Therapy Services 199 Ne Ironcreek Ter Hillsboro OR 97124-5150 Ph: () - | Laura Marie Separa Therapy Services 610 Sw Alder St Suite 1100 Portland OR 97205-3625 Ph: (503) 724-0943 |
| NPI Number | 1770022493 |
|---|---|
| Provider Enumeration Date | 02/14/2017 |
| Last Update Date | 02/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770022493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C4399 (Oregon) | Primary |
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